Glaucoma Flashcards
What NML IOP
10-21
Higher in the AM compared to PM
Aqueos humor is produced where?
Ciliary body
What are the two things you need to Dx glaucoma
optic nerve damage AND! visual field loss
What is the anatomical blind spot?
Optic disk
What are the two methods of doing a tonometry for glaucoma
-Non-contact = air puff
-Applanation = pressing on cornea with instrument
—Tonopen
!!Goldmann applanation = gold standard!!!
What is the gold standard to eval a tonometry
Goldman applanation
What is the only thing we can actually treat in glaucoma pts
IOP
If a pt has an IOP greater than 21, with a NML optic nerve, ant. Chamber, and no visual field loss
What is the approach
No Tx necessary, monitor annually
What are the RSK fx for developing glaucoma
Age
Large C/D ration
Thin central corneal thickness
Fm Hx
High Myopia
What is the patho phys of Primary open angle glaucoma
Loss of retinal nerve fiber layer (NFL) reduces vision
IOP greater than 28
A pt presents with a cc of tunnel vision
Think
Primary open angle glaucoma
What is the treatment approach to primary open angle glaucoma >?
Referal to ophthalmology/ optometry
And Rx that decrease the aqueous or increase the flow
What are the rx for primary open angle that decrease the production of aqueous
B-blockers
Alpha -2 adrenergics
(Brimonidine or apraclonidine)
Carbonic anhydrase inhibitors
(Dorso lamine, Brinzolamide, Acetazolamide)
What are the Rx for Primary open angle that increase the flow of aqueous
Sympathomimietics
(EPI, memantine)
Prostaglandin analogs
(-Prost)
Miotic agents
(Pilocarpine)
What are the ADE of using Alpha 2-adrenergics in POAG
Allergic conjunctivitis
Or contact dermatitis
What are the ADE of using prostaglandin analogs in POAG
Conjunctival Hyperemia
What are the surgical options for POAG that worsens or can be used early on in young pts
Argon Laser (plasty)
Or -ectomy (shunt)
Or ciliary body ablation
What is the IOP for normal tension glaucoma
Less than or equal to 21
What kind of glaucoma is associated with OSA
Normal tension
Due to decreased ocular perfusion
What are the manifestations of acute angle closure
Vision may be blurred
Typically unilateral
With monocular halos around lights
Frontal Headcahe with N/V
IOP of 60-80
A pt walks into the movie theater and has intense ocular eye pain with photophobia and a frontal headache
Unilateral blurred vision with a mid dilated pupil and shallow anterior chamber
Think
Acute Angel closure
More common in women,
What is the tx of choice for acute angle closure
Láser Iridotomy
Peripheral anterior synechiae are the pathology of what type of glaucoma
Chronic angle closure
PAS – front of iris binding to corneal endothelium
What are the S/s of Chronic angle closure
Intermittent eye pain, HA, and blurry vision
What is the tx approach to chronic angle closure
Trabeculectomy or tube shunt
- Areas of the angle not involved by PAS
- Prevent further synechial closure
Goniosynechialysis
-Designed to physically strip PAS
What etiology is associated with congenital glaucoma
Sturge-Weber syndrome (port-wine stain)
A child presents with a corneal diameter greater than 12 mm before age 1
Think
Congenital glaucoma
What id descemets membrane
Linear tears In the cornea seen in congenital glaucoma
Also may see haab striae (horizontal)
A 14mm cornea =
Megalocornea
What is the tx for congenital glaucoma
Oral acetazolmide
Topical B-blocks
(Timolol)
SRGY- Goniotomy
Or shunt
What is the tx for neovascular glaucoma
Timolol
Glaucoma filtration SRGRY
PRP
Should you give IOP lowering medication for steroid responce gluacoma ?
NO!
Just decrease or d/c steroid use
